Whiplash – Which Treatment Method Is Best?

Whiplash, or better termed, cervical acceleration-deceleration disorder (CAD) is primarily an injury to the soft tissues of the neck – that is, the muscles, their tendon insertions, and the ligaments that hold the joints firmly together. Neck pain is a very common health problem that affects between 10–15% of the population and drives people to all types of healthcare providers. We have previously discussed the reasons why whiplash /CAD injuries occur, the examination process and the prognosis aspects but the argument continues as to what treatment methods work the best when managing patients with CAD.

In the May 21, 2002 issue of the Annals of Internal Medicine, a group of medical doctors and PhD’s reported on neck pain treatment comparing traditional medical and physical therapy approaches verses spinal manipulation. In the study, they compared three common neck pain treatment approaches in a group of 183 patients with chronic neck pain (patients who had neck pain for more than 3 months). The 3 methods included traditional medical care which included medication utilization and rest, manual therapy (chiropractic adjustments) and physical therapy (active exercise training). After 7 weeks of treatment, the percentage of patients who felt either totally resolved (cured) or much improved were 68.3% receiving manual therapy / chiropractic care, 50.8% receiving physical therapy, and 35.9% receiving medical care.

The author, Jan Lucas Hoving, PhD reports that manual therapy / chiropractic was found to be more effective than the other 2 methods “…on almost all outcome measures,” not just a few! Further, although PT scored better than traditional medical care, “…most of the differences were not statistically significant,” meaning, not that much better. The authors appropriately reported that further study was needed to better understand the differences between methods.

In 2008, the “Decade Task Force” reviewed 10 years of studies on the treatment of neck pain and found similar results and referenced many studies that indicated spinal manipulation for neck pain, headaches, whiplash, and other neck related conditions was one of the most effective methods and that patients with neck pain should be given the option of receiving manual therapy / chiropractic before other approaches as it was found to be less expensive, faster in obtaining satisfying results (shorter course of disability), and most effective in terms of long-term benefits. This comparison discussion is by no means meant to minimize the importance of medical and PT care.

However, there appears to be a bias among patients with neck pain to seek medical care first when the studies clearly show chiropractic care is the preferred method. Hence, the purpose of this article is to educate the reader that their choice in treatment for neck pain should favor chiropractic care FIRST, not last. In fact, the sooner manipulation can be applied to the injured joints of the neck, typically the faster the results. For example, long term disability and chronic neck pain can occur from prolonged use of a cervical collar as the structures tighten and stiffen up from being immobile - unable to move because of the collar. Unless there is some unstable condition to the neck (fracture, grade 3 ligament tear, progressive neurological loss, etc.), studies support manipulation / early mobilization of the neck joints after injuries like whiplash verses wearing a cervical collar and rest.

Health Update: Headaches

The following are excerpts from the expert opinion of Dr. Joseph Cilea of the Advanced Wellness Center in Marlboro, New Jersey.
Pain Management
Acupuncture
Chiropractics
Spine Compression

  Chiropractic Care and Headaches

     "I can't believe how much my head hurts!"  I've been laid off from work for the last 3 weeks and worried about making my mortgage payment this month - I think the stress is getting out of control!  Pain starts in my neck and radiates into my head eventually making my whole head hurt, especially behind my eyes.  There are times I feel like my head might explode!  I can't stand loud noises or even normal noise.  Over the counter medications aren't touching it and I can't drive if I take some of the medications my doctor prescribed.  I don't know what to do next."

     This history is classic for the diagnosis of a tension-type of headache (TTH).  As unemployment rates reach new highs and stress levels climb, it is no wonder more and more people are presenting with this condition.  Even prior to the recession, TTH was the most common type of headache experienced by adults affecting 10-65% of the population.  The impact on daily living by TTH is significant as it disrupts daily activities, quality of life, and work.  These types of headaches, according to the International Headache Society (HIS), can last from 30 minutes to 7 days, do not include nausea/vomiting but may include increased sensitivity to light or noise (rarely both at the same time).  The most common frequency is less than 15 TTH's/month.

     Medication has been the primary medical form of treatment and some patients require the regular use of certain medications, even when headaches are not present - - as in some cases, it's too late to start meds once the headache starts.  In these cases, Amitriptyline has been the most frequently prescribed medication and it's considered the drug of choice for TTH.  Chiropractic spinal manipulation (CSM) has been reported to be helpful in a number of prior studies.  One reported equal benefit as Amitriptyline with 6 weeks of treatment.

     A recent publication conducted a study using a new design where TTH sufferers with more than 10 headaches per month were randomly assigned to one of four groups: 1) cervical spinal manipulation (CSM) + amitriptyline, 2) CSM + placebo (fake) amitriptyline; 3) sham CSM + real amitriptyline; or 4) sham CSM + placebo amitriptyline.  That way, one can determine which of the two or, the combination of both is most beneficial.  An initial period of 4 weeks was followed by a 14 week treatment period. A headache diary was used to track headache frequency in the last 28 days of the treatment period.  Nineteen completed the study and the combined effect carried the most statistically significant result with a close second with CSM alone.  A larger sample size was recommended for a more statistically powerful evaluation.

     This study is important as CSM by itself was found to be at least as (if not more) effective than Amitriptyline alone, which is the medication of choice for TTH.  Hence, if CSM or Amitriptyline alone are not found to be satisfying, the combination of the two is strongly supported by this study.

     If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service.  We are proud that chiropractic care has consistently scored the highest level of satisfaction when compared to other forms of health care provision and look forward in serving you and your family presently and in the future.

Health Update: Carpal Tunnel

The following are excerpts from the expert opinion of Dr. Joseph Cilea of the Advanced Wellness Center in Marlboro, New Jersey.
Pain Management
Acupuncture
Chiropractics
Spine Compression
 

Carpal Tunnel Syndrome (CTS) -  A "Typical" Case Example

     "I've been working on the line for 13 years and started noticing periodic tingling in my fingers.  It didn't last long and I didn't think about it much.  It gradually became more frequent and wouldn't go away when I changed my activity or shook my hand or fingers.  It started to really grab my attention when I started to drop things out of my hand and couldn't open jars as easily.  That's when I decided to see what was wrong.  I didn't know who to go to so I went to my family doctor and he diagnosed carpal tunnel syndrome.  He gave me a splint to wear at night and some anti-inflammatory drugs that irritated my stomach, so I quit the drugs.  The splint helped me sleep and I didn't wake up as often.  The doctor was talking about surgery to undo a pinch the nerve at my wrist if it didn't get better soon, but I overheard some co-workers talk about seeing a chiropractor for their carpal tunnel problems and how much better they felt so I decided to try it.

     "The chiropractor was very thorough and examined my neck, shoulder, elbow as well as my wrist and hand.  He indicated that several areas were putting pressure on the nerve that goes into the hand and the pinch was not just at the wrist but higher up in my neck, shoulder and forearm.  He said if I wasn't at least 50% better in 4 weeks, we would talk about other tests and treatment options and investigate it further.  He worked on my neck, shoulder, elbow, forearm and hand, using manipulations and other methods to loosen it up.  He said the nerve was getting pinched by the muscles working too fast and not getting enough rest.  He gave me exercises to do several times a day at work to stretch the forearm muscles and had me continue the use of the brace at night.  He also taught me how to ice massage the wrist for 5 minutes until it got numb, several times a day and he recommended I use vitamin B6, 50mg, three times a day.  After the 3rd week, I started to notice a decrease in the intensity, frequency and duration of numbness and weakness.  He had me fill out a Carpal Tunnel Questionnaire and my score improved a lot after the first 4 weeks.  He said he may have to evaluate my workstation and make some modifications, if possible.  He asked me a lot about the position of my wrist and hand when I work and didn't seem to like the type of screw driver I was using.  He called my boss and asked if a different type of screw driver with a power source and a pistol shaped handle could be tried and it was arranged.  That seemed to really make a difference."

     Carpal Tunnel Syndrome or CTS, is a common problem that is usually cumulative, slow and gradual in its onset, and can progress to a point where functions like buttoning shirts, threading a needle, and holding a newspaper are greatly affected.  People usually don't run to the doctor at the first signs of CTS as the initial symptoms are vague and initially not too impairing.  Over time, CTS can become quite severe and often prompts a surgical recommendation, without trying a non-surgical approach first.

     There are a number of studies published regarding the chiropractic management of CTS that show these non-surgical methods can be quite successful.  One compared medical care consisting of non-steroidal anti-inflammatory drugs and nocturnal wrist splinting to chiropractic care consisting of spine and extremity manipulation, nocturnal wrist splinting, and ultrasound over the wrist.  Both treatment approaches were helpful, suggesting the importance of trying either or even both of these non-surgical treatments prior to proceeding to surgery.

     We take pride in providing quality, evidence-based care and appreciate the opportunity to do so when patients choose our clinic for their care.  We realize there are many health care options available and truly appreciate the confidence shown by our patients when choosing our clinic for their health care needs.  If you, a friend or family member requires care for CTS, we would be honored to offer our services.

Health Update: Whiplash

Whiplash - Can This Really Happen To You?

The following are excerpts from the expert opinion of Dr. Joseph Cilea of the Advanced Wellness Center in Marlboro, New Jersey.

Pain Management
Acupuncture

     You're stopped at red light awaiting a left turn into the grocery store when out of nowhere, you  hear the screeching of tires, you turn your head and look into the rear view mirror and see that you're about to be hit from behind. Then "POW!"  The sudden force of the impact propels you back into your seat, your head hits the headrest and then bounces forwards, almost hitting the steering wheel.  You feel your body twist due to the angle of the seat belt and your sunglasses fly off and your purse sitting on the seat next to you flies into the dashboard and lands on the floor spilling its contents.  You're not sure what just happened as it all happened so fast.  Is this a dream?


     After collecting yourself and calming down, you get out of the car to inspect the damage and talk to the driver that just ran into you.  You notice that right now, you don't really hurt that much....but you feel kind of dazed.  When you inspect your car, you surprisingly notice very little damage, but it sure felt like your car should be totaled based on the way it felt.  The other driver said he was checking the station on the radio and saw you too late.  He tried to stop and slammed on the brakes but it was too late.  He said, "...I couldn't have been moving more than 5-10 mph when I hit you!"  You ask, "how could this possibly feel so.....hard an impact?  Was he lying to me?" There certainly wasn't much damage to your car...maybe he was right???  When he asked you if you would, "...let it go," and not call the police, you almost agree, but something stops you.  Even though there is little car damage and, "...he is a nice guy....," you just don't feel right in, "...letting it go." 
 

    Within 15-30 minutes, you're REALLY HAPPY you didn't give in and take his advice as by now, your neck is really starting to hurt. You feel kind of nauseated and light headed.  Your head is beginning to pound and you feel like you better sit down.  When the police officer approaches he seems distant and you're having difficulty hearing him.  Pretty soon, you notice others helping you onto a stretcher and attaching a neck brace prior to taking you to a local emergency room.  At the ER, you are confused about the details of the accident but piece together the best you can the events of the evening.  They take x-rays, recommend some Advil and ice, and tell you to contact your primary care physician if you have problems. They tell you that you're going to hurt for a few days and "...that 's normal."  However, over the next several days, pain intensifies to a point where neck and headache pain is constant, you can't sleep, your memory seems blurry, you can't seem to concentrate and loose your place during thought and conversation....something is REALLY WRONG!


     This scenario is not atypical of a low speed collision related injury.  In fact, the less the car is damaged, the greater the impact is to the contents inside the car (this is called "elastic deformity").  That's because crushing metal absorbs the energy of the force (ie, "plastic deformity) and if the speed is "...too low" and little metal crushing/energy absorption occurs, the G-forces that occurred during the collision are transferred to the contents inside the vehicle and that force can be significantly greater than a crash that occurs at 2-4 times the 5-10 mph speed.  In general, when there is less damage to the car, be alert that the force exerted on the contents is greater than when car damage occurs.  This is why when cars crash during a car race, the race car basically falls apart, leaving the driver enclosed in a cage that prevents bodily damage, and they often walk away from the accident.


     If you, a loved one, or a friend is struggling with whiplash residuals from a motor vehicle collision, you can depend on receiving a multi-dimensional assessment and therapeutic approach at our chiropractic facility.